Aim: Psychiatric morbidities seem to be one of the biggest hurdles in the stigmatized people of transgender. Lack of knowledge and ignorance with ever-growing abuse over this population make them vulnerable for mental instability. This study is an attempt to identify and access the psychiatric morbidities of gender dysphoric people of Imphal, Manipur. Materials and Methods: Using DSM-5 all qualified, consenting gender dysphoric people were assessed for psychiatric morbidities using Mini-International Neuropsychiatry Interview-Plus scale at Imphal, Manipur, and the results were compared using Chi-square test. Results: Substance use disorders were found in the majority of them. Twenty (62.5%) of them had current alcohol abuse, and 10 (31.2%) of them were dependent of alcohol. Fifteen (46.8%) of them were abusing other nonalcoholic psychotropic drugs. Twelve (37.5%) were suffering from generalized anxiety disorder (GAD) followed by 10 (31.2%) with current depressive disorder. Past suicidal attempts were found among 10 (31.2%) of them with 14 (41.2%) out of them for having current suicidal risk. Six (18.7%) of them were having dysthymia, 2 (6.2%) had panic disorder, 3 (9.4%) had agoraphobia and posttraumatic stress disorder, respectively, 8 (25%) suffered from social phobia, and 1 (3.2%) from specific phobia for spiders. Conclusions: This study found high prevalence of comorbid psychiatric disorders of which alcohol use disorder was the prominent one. Other psychiatric disorders such as GAD, depression, and suicidal risk were also found to be higher among these people. As this population is at higher risk of developing other psychiatric problems, regular screening and timely intervention is needed to prevent or treat psychiatric comorbidities.

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Fluvoxamine is one of the commonly used selective serotonin reuptake inhibitors (SSRIs) as a first-line treatment for obsessive-compulsive disorder (OCD). Galactorrhea is a rarely observed adverse effect of SSRIs occurring through complex interactions between serotonergic and dopaminergic systems of brain. We report a case of fluvoxamine-induced reversible euprolactinemic galactorrhea in a 39-year-old woman after initiation of fluvoxamine for OCD. The patient's galactorrhea resolved on discontinuation of fluvoxamine.

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Background: The risk of lead exposure for mental illness and its burden on Indian children, as a society, is not studied till date. This study aims to present the same as well as to compare the risk and burden between 1990 and 2015. Materials and Methods: Using India-specific, Global Burden of Disease 2015 data health metrics-disability-adjusted life years (DALYs), we estimated the burden of mental illness and exposure to lead as a risk factor for the same. Descriptive estimates of prevalence and DALY for mental illness and risk of lead exposure are presented for various age groups of Indian children (0–14 years) of either gender. Results: In 2015, 26,450,345 Indian children were affected with mental illness contributing to DALYs of 2,453,344. In 2015, 162,492.1 DALYs were lost to mental illness due to risk factors and 130,429 lost DALYs due to risk attributed to lead exposure. The risk rate attribution and the difference of burden in 1990–2015 are presented. Years of life lost due to lead exposure for mental illness is high as compared to all attributed risks. Lead was identified as risk factor for intellectual disability among children. Conclusions: Lead continues to pose a significant overall health risk and specifically for mental illness. The estimated burden of mental illness and extent of association of risk indicate the urgent need of clear policies to reduce lead from our immediate environment.

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Context: The number of elderly patients is expected to rise. However, the efforts required to integrate this aging population into our health-care system seem to be lacking. An improvement definitely has to be aimed for because the subject of geriatric medicine will personally concern each one of us in the future. Aims: This study aims to assess and compare knowledge, attitude, and perception toward elderly and aging in medical interns and postgraduate residents and compare attitudes toward aging among the different postgraduate branches. Settings and Design: This study was conducted at a tertiary care teaching municipal hospital and medical college. This was a cross-sectional study utilizing self-constructed structured questionnaires. Materials and Methods: Questionnaires on knowledge, attitude, and perception, constructed by the lead researcher and reviewed by an expert panel, were administered to the two groups. The responses were collected and analyzed. Statistical Analysis Used: Chi-square test and means of percentages were used. Results: Both groups showed a positive perception to the needs of the elderly. The interns showed a more negative attitude toward aging compared to the postgraduate students, with the differences being significant (P < 0.05) between the two groups in 16 out of 45 questions. On the knowledge questionnaire, a significant (P = 0.014) difference was seen between the teaching in interns and postgraduates. The analysis also revealed that general medicine and psychiatry had the best scores on the attitude questionnaire. Conclusions: Although the perception of elder-friendly city is same in both groups, interns have a more negative attitude toward aging which could stem from the inadequate knowledge being imparted during the undergraduate medical curriculum. Hence, there is a need to introduce geriatric medicine at an undergraduate level.

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Background: Occupational stress is common in nurses. Stress can impact the health of the nurses leading to somatic complaints. Aims and Objectives: (1) To determine the extent and causes of occupational stress among nurses at Bhabha Atomic Research Centre Hospital. (2) To compare the stress levels among nurses depending on their years of experience. (3) To study any correlation between stress levels and the extent of somatic complaints. Materials and Methods: Ninety-seven staff nurses without any preexisting psychiatric illness were evaluated for occupational stress using the Expanded Nursing Stress Scale. The extent of somatization was measured using the Patient Health Questionnaire – 15, in a cross-sectional study. Cronbach's alpha, analysis of variance, and Spearman's correlation co-efficient test were applied to the data. Results: An internal consistency of 0.945 was noted using Cronbach's alpha. 51.5% nurses experienced mild, 34% experienced moderate, and 2.10% experienced severe stress. Conflicts with supervisors, patients, and their families and workload were the main causes of occupational stress while discrimination was the least affected domain. Nurses with 6–10 years of experience had maximum stress. The stress levels correlated with the extent of somatic complaints. Conclusions: Occupational stress is prevalent in nurses. It may be higher in nurses with lesser experience and it can be associated with somatic complaints.

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Context: This hospital-based study attempts to explore the morbidity load of categorized mental disorders along with the pattern of substance use in the adolescent group of people presenting to a tertiary hospital of Manipur, India. Aims: This study aims to document sociodemographic profiles, psychiatric morbidity, and substance use pattern among the adolescents attending the Department of Psychiatry of a tertiary hospital of Manipur, India. Settings and Design: This study was a cross-sectional, hospital-based study. Subjects and Methods: This cross-sectional study included 474 consecutive adolescent patients (10–19 years) attending both outpatient department and inpatient department of the Department of Psychiatry of a Tertiary Hospital of Manipur, India, were enrolled during the study. Diagnoses were made according to the ICD-10. Statistical Analysis: The statistical software, namely SPSS 22.0 and R environment ver. 3.2.2 were used for the analysis of the data. Results: Almost 68.4% were within 16–19 years, 51.3% lived with their families, 56.1% were male, 62% of them were Hindus, and majority of them were from urban background (54.4%). Neurotic, stress-related, and somatoform disorders were the highest (41.4%), followed by psychotropic substance use in 21.3%, mood disorders in 14.8%, schizophrenia and delusional disorder in 12.2%, behavioral and emotional disorder in 9.3%, and disorders of adult personality and behavior (F60-69) in 0.4%. The most common categorical psychiatric diagnosis in males due to psychotropic substance use (37.2%) while neurotic, stress-related, and somatoform disorders (61.1%) were the most common categorical diagnosis in females. Conclusions: Very few studies have been conducted to reflect the scenario and pattern of psychiatric morbidities in the state of Manipur. We hope this study will be helpful in reflecting the psychiatric morbidity load in the adolescent group for helping them with early diagnosis and intervention.

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Context: Attitudes of paramedical and medical professionals to psychiatric illnesses are important for referral and use of mental health facilities by general people. Knowledge of psychiatric disorders and experience of working with psychiatric patients may be responsible for positive attitudes. Aims: The aim was to assess attitude toward different mental illnesses among different paramedical professionals and to know the impact of education and work experience on attitudes toward mental illnesses. Subjects and Methods: Study sample was nursing staff, nursing students, and junior doctors from tertiary care hospital and students of clinical psychology from a private deaddiction center. The study design was cross-sectional. Attitude to Mental Illness Questionnaire was used with modifications and addition of demographic details. Experience of working with psychiatric patients and attending mental health primary care (MHPC) program also were included for the evaluation of attitudes. Results: Attitudes toward drug abuse, depression, alcohol abuse, and schizophrenia were more negative while toward anxiety spectrum disorders, conversion, and dissociative disorders were more positive. Subjects with experience of working with psychiatric patients and experience of MHPC program showed more positive attitudes. Conclusions: There is need of, developing program containing knowledge of mental health, implementing practical experience of working with psychiatric patients in the curriculum of paramedical and medical profession and restructuring present curriculum to develop positive attitudes to mental illnesses for benefit of community.

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Office-based psychotherapy practice is a challenging and vexing task for psychiatrists. Psychotherapy has not yet found a firm footing as an accepted form of therapy by many patients. Psychiatrists offering psychotherapy as a treatment face many challenges that may be social, psychological, and ethical. The present review paper posits an overview of the various challenges that besiege office-based psychotherapy in private psychiatric practice. Issues right from the initiation and basic premise of describing psychotherapy and issues concerning its mechanism of action and efficacy along with individualization of therapy are discussed. The challenges of online psychotherapy and dealing with clients that refuse medical help along with the perils of eclectic psychotherapy are highlighted. Handling adolescents which poses many challenges is also discussed along with an emphasis on the sound termination of psychotherapy. The paper aims to sensitize the readers to the various challenges that office-based psychotherapy poses while providing an overview on the subject. Each of the challenges in this paper is subtopics in themselves and may warrant separate review papers in their own right.

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